Comparison of Treatment Regimens in Management of Severe Hypercalcemia Due to Vitamin D Intoxication in Children

J Clin Res Pediatr Endocrinol. 2019 May 28;11(2):140-148. doi: 10.4274/jcrpe.galenos.2018.2018.0131. Epub 2018 Nov 5.


Objective: No large study has been conducted to date to compare the effectiveness of prednisolone, alendronate and pamidronate as first-line treatment in children with hypercalcemia due to vitamin D intoxication. The aim was to perform a multicenter, retrospective study assessing clinical characteristics and treatment results.

Methods: A standard questionnaire was uploaded to an online national database system to collect data on children with hypercalcemia (serum calcium level >10.5 mg/dL) due to vitamin D intoxication [serum 25-hydroxyvitamin D (25(OH)D) level >150 ng/mL] who were treated in pediatric endocrinology clinics.

Results: Seventy-four children [median (range) age 1.06 (0.65-1.60) years, 45 males (61%) from 11 centers] were included. High-dose vitamin D intake was evident in 77% of the cases. At diagnosis, serum calcium, phosphorus, alkaline phosphatase, 25(OH)D and parathyroid hormone concentrations were 15±3.2 mg/dL, 5.2±1.2 mg/dL, 268±132 IU/L, 322 (236-454) ng/mL, and 5.5 (3-10.5) pg/mL, respectively. Calcium levels showed moderate correlation with 25(OH)D levels (rs=0.402, p<0.001). Patients were designated into five groups according to the initial specific treatment regimens (hydration-only, prednisolone, alendronate, pamidronate, and combination). Need for another type of specific drug treatment was higher in children who initially received prednisolone (p<0.001). Recurrence rate of hypercalcemia was significantly lower in children who were treated with pamidronate (p=0.02).

Conclusion: Prednisolone is less effective in the treatment of children with severe hypercalcaemia secondary to vitamin D intoxication and timely implementation of other treatment regimens should be considered.

Keywords: Nutrition; rickets; stoss therapy; steroid; over-the-counter drugs.

Publication types

  • Comparative Study
  • Multicenter Study

MeSH terms

  • Bone Density Conservation Agents / therapeutic use*
  • Female
  • Follow-Up Studies
  • Humans
  • Hypercalcemia / blood
  • Hypercalcemia / chemically induced
  • Hypercalcemia / drug therapy*
  • Hypercalcemia / pathology
  • Infant
  • Male
  • Pamidronate / therapeutic use*
  • Prognosis
  • Retrospective Studies
  • Vitamin D / adverse effects*
  • Vitamin D / blood
  • Vitamins / adverse effects*
  • Vitamins / blood


  • Bone Density Conservation Agents
  • Vitamins
  • Vitamin D
  • Pamidronate